Boosz Alexander Stephan, Reimer Peter, Matzko Matthias, Römer Thomas, Müller Andreas
Städtisches Klinikum Karlsruhe, Department of Gynecology and Obstetrics, Frauenklinik des Evangelischen Krankenhauses Köln Weyertal, Städtisches Klinikum Karlsruhe, Institute of Diagnostic and Interventional Radiology, FUS Center, Dachau Medical Center.
Dtsch Arztebl Int. 2014 Dec 22;111(51-52):877-83. doi: 10.3238/arztebl.2014.0877.
Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum of available treatments has been widened by the introduction of new drugs and interventional procedures.
Selective literature review on the treatment of uterine fibroids, including consideration of several Cochrane Reviews.
Fibroids can be treated with drugs, interventional procedures (uterine artery embolization [UAE] and focused ultrasound treatment [FUS]), and surgery. The evidence regarding the various available treatments is mixed. All methods improve symptoms, but only a few comparative studies have been performed. A meta-analysis revealed that recovery within 15 days is more common after laparoscopic enucleation than after open surgery (odds ratio [OR], 3.2). A minimally invasive hysterectomy, or one performed by the vaginal route, is associated with a shorter hospital stay and a more rapid recovery than open transabdominal hysterectomy. UAE is an alternative to hysterectomy for selected patients. The re-intervention rates after fibroid enucleation, hysterectomy, and UAE are 8.9-9%, 1.8-10.7%, and 7-34.6%, respectively. The main drugs used to treat fibroids are gonadotropin-releasing hormone analogs and selective progesterone receptor modulators.
Multiple treatment options are available and enable individualized therapy for symptomatic fibroids. The most important considerations in the choice of treatment are the question of family planning and, in some cases, the technical limitations of the treatments themselves.
子宫肌瘤是女性最常见的良性肿瘤。三分之一的育龄女性因有症状的子宫肌瘤接受治疗。近年来，新药物和介入手术的引入拓宽了可用治疗方法的范围。
对子宫肌瘤治疗的选择性文献综述，包括参考多篇Cochrane系统评价。
子宫肌瘤可采用药物、介入手术（子宫动脉栓塞术[UAE]和聚焦超声治疗[FUS]）及手术治疗。关于各种可用治疗方法的证据不一。所有方法均能改善症状，但仅进行了少数比较研究。一项荟萃分析显示，腹腔镜肌瘤剥除术后15天内恢复的情况比开腹手术更常见（优势比[OR]，3.2）。微创子宫切除术或经阴道途径的子宫切除术与开腹经腹子宫切除术相比，住院时间更短，恢复更快。UAE是特定患者子宫切除术的替代方法。肌瘤剥除术、子宫切除术后和UAE后的再次干预率分别为8.9%-9%、1.8%-10.7%和7%-34.6%。用于治疗子宫肌瘤的主要药物是促性腺激素释放激素类似物和选择性孕激素受体调节剂。
有多种治疗选择，可为有症状的子宫肌瘤提供个体化治疗。选择治疗方法时最重要的考虑因素是计划生育问题，在某些情况下，还有治疗方法本身的技术局限性。
